Elisabetta Pupillo1, Marco Poloni1, Elisa Bianchi1, Giorgia Giussani1, Giancarlo Logroscino2,3, Stefano Zoccolella2, Adriano Chiò4, Andrea Calvo4, Massimo Corbo5, Christian Lunetta6, Benoit Marin7,8, Douglas Mitchell, Orla Hardiman9, James Rooney9, Zorica Stevic10, Monica Bandettini di Poggio11, Massimiliano Filosto12, Maria Sofia Cotelli13, Michele Perini14, Nilo Riva15, Lucio Tremolizzo16, Eugenio Vitelli17, Danira Damiani1, Ettore Beghi1. 1. a Laboratorio di Malattie Neurologiche , IRCCS-Istituto Mario Negri , Milano , Italy. 2. b Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy. 3. c Unit of neurodegenerative Diseases, Department of Clinical Research in Neurology , University of Bari "Aldo Moro", at "Pia Fondazione Cardinale G. Panico" , Lecce , Italy. 4. d Centro SLA, Dipartimento di Neuroscienze 'Rita Levi Montalcini' , Università di Torino , Torino , Italy. 5. e Department of Neurorehabilitation Sciences , Casa Cura Policlinico, CCP , Milano , Italy. 6. f Centro Clinico NEMO, Fondazione Serena Onlus , ASST Grande Ospedale Metropolitano Niguarda , Milano , Italy. 7. g INSERM, U1094 , Tropical Neuroepidemiology , Limoges , France. 8. h Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology , Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST , Limoges , France. 9. i Academic Unit of Neurology , Trinity Biomedical Sciences Institute, Trinity College Dublin , Dublin , Ireland. 10. j Clinic of Neurology Clinical Center Serbia , School of Medicine , Belgrade , Serbia. 11. k Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) , University of Genova , Genova , Italy. 12. l Unit of Neurology, Spedali Civili di Brescia , Brescia , Italy. 13. m Department of Neurology, Ospedale di Esine , Brescia , Italy. 14. n Divisione Neurologica , Ospedale di Gallarate , Gallarate , Italy. 15. o Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience , San Raffaele Scientific Institute , Milan , Italy. 16. p ALS Unit, University of Milano-Bicocca , Monza , Italy. 17. q Department of Neurology, Azienda Ospedaliera della Provincia di Lodi , Lodi , Italy.
Abstract
OBJECTIVES: To assess the association between amyotrophic lateral sclerosis (ALS) and previous traumatic events, age of trauma, and site of injury. METHODS: A population-based case-control study was performed in five European countries (Italy, Ireland, France, United Kingdom, Serbia). Newly diagnosed ALS patients and matched controls were interviewed to collect relevant demographic factors and exposures. Key clinical features at diagnosis were collected in ALS patients. Trauma was any accidental event causing an injury. Injuries were dated and classified according to cause, severity, type, site, and complications. All exposures were censored five years before symptoms onset. Risks were computed as odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariate conditional logistic regression models. RESULTS: Five hundred and seventy-five ALS patients and 1150 controls were interviewed. Disabling traumatic events predominated in the cases (OR 1.54 (95% CI 1.24-1.92)) and maintained significance after adjustment, with a significant gradient. A history of 2 + head injuries was associated with an almost three-fold increased risk of ALS. The risk was almost two-fold when trauma occurred at age 35-54 years. Site of injury was uneventful. CONCLUSIONS: Traumatic events leading to functional disability or confined to the head are risk factors for ALS. Traumatic events experienced at age 35-54 years carry the highest risk.
OBJECTIVES: To assess the association between amyotrophic lateral sclerosis (ALS) and previous traumatic events, age of trauma, and site of injury. METHODS: A population-based case-control study was performed in five European countries (Italy, Ireland, France, United Kingdom, Serbia). Newly diagnosed ALSpatients and matched controls were interviewed to collect relevant demographic factors and exposures. Key clinical features at diagnosis were collected in ALSpatients. Trauma was any accidental event causing an injury. Injuries were dated and classified according to cause, severity, type, site, and complications. All exposures were censored five years before symptoms onset. Risks were computed as odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariate conditional logistic regression models. RESULTS: Five hundred and seventy-five ALSpatients and 1150 controls were interviewed. Disabling traumatic events predominated in the cases (OR 1.54 (95% CI 1.24-1.92)) and maintained significance after adjustment, with a significant gradient. A history of 2 + head injuries was associated with an almost three-fold increased risk of ALS. The risk was almost two-fold when trauma occurred at age 35-54 years. Site of injury was uneventful. CONCLUSIONS:Traumatic events leading to functional disability or confined to the head are risk factors for ALS. Traumatic events experienced at age 35-54 years carry the highest risk.
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